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Item 1. Business

2023-03-30 compared with 2022-03-31 · 746 added, 159 removed, 360 unchanged (72% of the section changed)

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We focus on diseases with serious, life-threatening consequences and those where current treatment options are limited specifically in NASH (non-alcoholic steatohepatitis) with cirrhosis and certain cancer indications.

Our strategy is to

establish and implement clinical development programs that add value to our business in the shortest period of time possible and to seek strategic partners when one of our programs becomes advanced and requires significant additional resources.

Our strategy is

to establish and implement clinical development programs that add value to our business in the shortest period of time possible and to seek strategic partners when one of our programs becomes advanced and requires significant additional

Our lead galectin-3 inhibitor is belapectin (GR-MD-02), which has been demonstrated in preclinical models to reverse liver fibrosis and cirrhosis and in clinical studies to decrease portal hypertension and prevent

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clinical study in NASH patients with advanced fibrosis (NASH-FX) and a second Phase 2b clinical trial in NASH patients with compensated cirrhosis and portal hypertension (NASH-CX).

We are now engaged in a large, global Phase 2b/3 clinical trial.

Our study protocol was filed with the FDA on April 30, 2020, for a seamless adaptively-designed Phase 2b/3 clinical study, the NAVIGATE trial

(formerly called NASH-RX), evaluating the safety and efficacy of our galectin-3 inhibitor, belapectin, for the prevention of esophageal varices in patients with non-alcoholic steatohepatitis (NASH) cirrhosis (Further details are available at www.clinicaltrials.gov

under study NCT04365868);

In February 2023, we completed randomizations totaling 357 patients in a large, global Phase 2b/3 clinical trial.

Our study protocol was filed with the FDA on April 30, 2020, for a seamless adaptively-designed

Phase 2b/3 clinical study, the NAVIGATE trial, evaluating the safety and efficacy of our galectin-3 inhibitor, belapectin, for the prevention of esophageal varices in patients with non-alcoholic steatohepatitis (NASH) cirrhosis (Further details

are available at www.clinicaltrials.gov under study NCT04365868);

this study began enrolling patients in Q2-2020.

In September 2020, the Company received a letter from the FDA providing comments, asking questions and providing guidance on various aspects of the ongoing NAVIGATE trial.

In September 2020, the Company received a letter from the FDA providing comments, asking questions and providing guidance

on various aspects of the ongoing NAVIGATE trial.

These comments were addressed, and the study proceeded accordingly.

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We are also pursuing a development pathway to clinical enhancement and commercialization for our lead compounds in immuno-oncology following our previous successful collaboration with Providence Portland Cancer

We are now planning a phase 2 trial in advanced or metastatic head and neck cancer using belapectin in combination with a checkpoint (PD-1) inhibitor.

All of our proposed products are presently in development, including pre-clinical and

clinical trials.

In 2022, we filed a new IND with FDA for advanced or metastatic head and neck cancer using belapectin in combination with a checkpoint (PD-1) inhibitor and received a Study May Proceed letter.

The proposed phase 2 trial commencement is

dependent on timing of financing.

All of our proposed products are presently in development, including pre-clinical and clinical trials.

We were founded in July 2000 as Pro-Pharmaceuticals, Inc., a Massachusetts corporation.

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On May 26, 2011, Pro-Pharmaceuticals, Inc.

changed its name to “Galectin Therapeutics Inc.” In October 2012, we moved our headquarters to a suburb of Atlanta, GA to be closer to a

center of discovery collaboration while maintaining a laboratory operation in the Boston area.

changed its name to “Galectin Therapeutics Inc.” In October 2012, we moved our headquarters to a suburb of Atlanta, GA to be closer to

a center of discovery collaboration while maintaining a laboratory operation in the Boston area.

Our Drug Development Programs

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proteins, called glycoproteins that are responsible for various functions within the body, most notably inflammation and fibrosis.

Galectins, in particular galectin-3,act as a molecular glue, bringing together molecules that have sugars on them.

Galectin-3, is known to be markedly increased in a number of important diseases including inflammatory diseases leading to organs scarring (e.g.

Galectins, in particular galectin-3,act as a molecular glue, bringing together molecules that have sugars on

Galectin-3, is known to be markedly increased in a number of significant diseases including inflammatory diseases leading to organs scarring (e.g.

liver, lung, kidney, and heart) and cancers.

The increase in galectin-3 , by creating the so-called

galectin-3 fibrosome, promotes the progression of multiple diseases.

The increase in galectin-3, by creating the

so-called galectin-3 fibrosome, promotes the progression of multiple diseases.

Published data substantiating the importance of galectin-3 in the fibrotic process arises from gene knockout experiments in animal studies.

For instance, mice genetically

altered to eliminate the galectin-3 gene, and thus unable to produce galectin-3, do not develop liver fibrosis in response to toxic insult to the liver.

We have one new proprietary chemical entity (NCE) in development, belapectin, which has shown promise in preclinical and clinical studies for the treatment of liver fibrosis, severe skin disease, and cancer (melanoma

and head and neck squamous cell carcinoma).

For instance, mice

genetically altered to eliminate the galectin-3 gene, and thus unable to produce galectin-3, do not develop liver fibrosis in response to toxic insult to the liver.

(melanoma and head and neck squamous cell carcinoma).

Currently, we are focusing on development of belapectin for the treatment of NASH cirrhosis and head and neck cancer.

Belapectin is a proprietary, patented compound derived from natural, plant-based,

starting materials, which, following chemical processing, exhibits the properties of binding to and inhibiting galectin-3.

Belapectin is a proprietary, patented compound derived from natural,

plant-based, starting materials, which following chemical processing, exhibits the properties of binding to and inhibiting galectin-3.

Our product pipeline is shown below:

Prevention of esophageal varices in NASH cirrhosis

Prevention of esophageal varices in

NASH cirrhosis

Phase 1 interaction trial:

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Its principal purpose was to evaluate various imaging modalities.

The NASH FX trial top line data was reported in September 2016 and

published in Alimentary Pharmacology and Therapeutics in 2016.

The NASH FX trial top line data was

reported in September 2016 and published in Alimentary Pharmacology and Therapeutics in 2016.

The Phase 2 NASH CX trial was conducted in patients with compensated cirrhosis and portal hypertension.

The NASH CX trial top line data was reported in December 2017 and was published in Gastroenterology

The NASH CX trial top line data was reported in December 2017 and was published in Gastroenterology in 2020.

NASH NAVIGATE

Following FDA feedback, the NAVIGATE trial is an adaptive Phase 2b/3 trial for the prevention of esophageal varices in NASH patients with compensated cirrhosis and clinical signs of portal hypertension.

A Phase 2b interim efficacy

analysis will be incorporated to confirm previous Phase 2 data, select an optimal dose and reaffirm the risk/benefit of belapectin.

The Phase 3 end of study analysis will evaluate the development of esophageal varices as the same primary

outcome of efficacy and a composite clinical endpoint including progression to varices requiring treatment as a key secondary outcome of efficacy ( www.clinicaltrials.gov NCT04365868).

The first patient was randomized in the third quarter

Phase 2b interim efficacy analysis will be incorporated to confirm previous Phase 2 data, select an optimal dose and reaffirm the risk/benefit of belapectin.

The Phase 3 end of study analysis will evaluate the development of

esophageal varices as the same primary outcome of efficacy and a composite clinical endpoint including progression to varices requiring treatment as a key secondary outcome of efficacy ( www.clinicaltrials.gov NCT04365868).

patient was randomized in February 2023.

Phase 1 study:

hepatic insufficiency

A hepatic impairment study is being conducted in subjects with normal hepatic function and subjects with varying degrees of hepatic impairment (www.clinicaltrials.gov NCT04332432) and began

enrolling patients in the second quarter of 2020.

A hepatic impairment study is being conducted in subjects with normal hepatic function and subjects with varying degrees of hepatic impairment (www.clinicaltrials.gov NCT04332432) and began enrolling

patients in the second quarter of 2020.

The study completed enrollment in February 2022.

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Carcinoma (HNSCC)

Investigator IND study in process.

Investigator IND study was completed.

A Phase 1B study began in Q-1 2016.

Early data was reported in February 2017 and additional data were reported in September 2018.

Data from an extension trial was reported in July 2021 for additional

melanoma and HNSCC patients which provided a rational basis for additional trials which the Company is exploring.

Data from an extension trial was reported in July 2021 for

additional melanoma and HNSCC patients which provided a rational basis for additional trials which the Company is exploring.

In the third quarter of 2022, the Company announced its IND application for belapectin in combination with

a checkpoint inhibitor for the treatment of HNSCC was filed and a Study May Proceed letter was received from FDA.

The Company is reviewing options for financing this trial which will determine when such trial could commence.

Liver cirrhosis.

Belapectin is our lead product

candidate for treatment of compensated NASH cirrhosis in patients with portal hypertension.

Belapectin is our lead product candidate for treatment of compensated NASH cirrhosis in patients with portal hypertension.

Our preclinical data show that belapectin has a significant therapeutic effect on liver fibrosis as shown in several relevant animal models.

addition, in NASH animal models, belapectin has been shown to reduce liver fat, inflammation, portal pressure, and ballooning degeneration (death of liver cells).

Therefore, we chose belapectin as the lead candidate in a development program

targeted initially at fibrotic liver disease associated with non-alcoholic steatohepatitis (NASH).

In January 2013, an Investigational New Drug (“IND”) was submitted to the FDA with the goal of initiating a Phase 1 study in patients with NASH

and advanced liver fibrosis to evaluate the safety of belapectin and pharmacodynamics biomarkers of disease.

On March 1, 2013, the FDA indicated we could proceed with a US Phase 1 clinical trial for belapectin with a development program aimed

at obtaining support for a proposed indication of belapectin for treatment of NASH with advanced fibrosis.

In addition, in NASH animal models, belapectin has been shown to reduce liver fat,

inflammation, portal pressure, and ballooning degeneration (death of liver cells).

Therefore, we chose belapectin as the lead candidate in a development program targeted initially at fibrotic liver disease associated with non-alcoholic

steatohepatitis (NASH).

In January 2013, an Investigational New Drug (“IND”) was submitted to the FDA with the goal of initiating a Phase 1 study in patients with NASH and advanced liver fibrosis to evaluate the safety of belapectin and

pharmacodynamics biomarkers of disease.

On March 1, 2013, the FDA indicated we could proceed with a US Phase 1 clinical trial for belapectin with a development program aimed at obtaining support for a proposed indication of belapectin for

treatment of NASH with advanced fibrosis.

The Phase 1 trial was completed and demonstrated that belapectin up to 8 mg/kg Lean Body Mass (LBM), i.v.

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NASH-FX Trial:

The NASH-FX trial was a Phase 2a

pilot trial for patients with NASH and advanced fibrosis that explored use of three non-invasive imaging technologies.

It was a short, single site, four-month trial in 30 NASH patients with advanced fibrosis (F3) randomized 1:1 to either 9

bi-weekly doses of 8 mg/kg LBM of belapectin or placebo.

The trial did not meet its primary endpoint as measured using multi-parametric magnetic resonance imaging (LiverMultiScan (R) , Perspectum Diagnostics).

The trial also did not meet secondary endpoints that measure liver stiffness as a surrogate for fibrosis using, magnetic resonance-elastography and FibroScan ® score.

With a four-month treatment period and a small number of patients per arm the study was not powered to demonstrate efficacy results in established advanced liver fibrosis.

however, belapectin was found to be safe and well tolerated with no serious adverse events and showing evidence of a pharmacodynamic effect.

The NASH-FX trial was a Phase 2a pilot trial for patients with NASH and advanced fibrosis that explored use of three non-invasive imaging technologies.

a short, single site, four-month trial in 30 NASH patients with advanced fibrosis (F3) randomized 1:1 to either 9 bi-weekly doses of 8 mg/kg LBM of belapectin or placebo.

The trial did not meet its primary endpoint as measured using

multi-parametric magnetic resonance imaging (LiverMultiScan (R) , Perspectum Diagnostics).

The trial also did not meet secondary endpoints that measure liver

stiffness as a surrogate for fibrosis using, magnetic resonance-elastography and FibroScan ® score.

With a four-month treatment period and a small number of

patients per arm the study was not powered to demonstrate efficacy results in established advanced liver fibrosis.

In the trial however, belapectin was found to be safe and well tolerated with no serious adverse events and showing evidence of a

pharmacodynamic effect.

These results provided support for further development in NASH.

NASH-CX Trial:

The NASH-CX trial was a larger

multi-center clinical trial that explored the use of belapectin for the treatment of patients with well-compensated NASH cirrhosis and portal hypertension.

Enrollment was completed in September 2016, and a total of 162 patients at 36 sites in

the United States were randomized to receive either 2 mg/kg LBM of belapectin, 8 mg/kg LBM of belapectin or placebo.

The NASH-CX trial was a larger multi-center clinical trial that explored the use of belapectin for the treatment of patients with well-compensated NASH cirrhosis and portal hypertension.

Enrollment was completed in September 2016, and a total of 162 patients at 36 sites in the United States were randomized to receive either 2 mg/kg LBM of belapectin, 8

mg/kg LBM of belapectin or placebo.

Approximately 50% of patients at baseline had esophageal varices (a complication of portal hypertension).

The primary endpoint

was a reduction in hepatic venous pressure gradient (HVPG), a hemodynamic measure that estimates portal hypertension.

Patients received an infusion of belapectin or placebo every other week for one year and were evaluated to determine the

change in HVPG as compared with placebo.

Secondary or exploratory endpoints included evaluation of fibrosis on liver biopsy, measurement of liver stiffness (FibroScan (R) )

and assessment of liver metabolism ( 13 C-methacetin breath test).

Top line data readout was reported in December 2017.

The study demonstrated a favorable safety

profile and clinically meaningful efficacy results in patients without esophageal varices at baseline as demonstrated by a decrease in portal pressure associated with the prevention of development of varices when compared to placebo.

The primary endpoint was a reduction in hepatic venous pressure gradient (HVPG), a hemodynamic measure

that estimates portal hypertension.

Patients received an infusion of belapectin or placebo every other week for one year and were evaluated to determine the change in HVPG as compared with placebo.

Secondary or exploratory endpoints included

evaluation of fibrosis on liver biopsy, measurement of liver stiffness (FibroScan) and assessment of liver metabolism ( 13 C-methacetin breath test).

Top line data

readout was reported in December 2017.

The study demonstrated a favorable safety profile and clinically meaningful efficacy results in patients without esophageal varices at baseline as demonstrated by a decrease in portal pressure associated

with the prevention of development of varices when compared to placebo.

In the total patient population, the primary endpoint HVPG showed a trend toward benefit with belapectin treatment, but the difference from placebo was not statistically significant.

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equal to or greater than 2 mm Hg decrease in HVPG from baseline or those with an equal to or greater than 2 mm Hg and a greater than or equal to 20% decrease in HVPG from baseline.

In both cases, the change observed in the belapectin 2 mg/kg LBM

group was statistically significant (p<0.01) while that of the 8 mg/kg LBM group was not.

In both cases, the change observed in the belapectin 2 mg/kg

LBM group was statistically significant (p<0.01) while that of the 8 mg/kg LBM group was not.

Over the 54-week treatment period, in patients without varices at baseline there were also a statistically significantly fewer new varices that developed in the belapectin treatment groups (0% and 4% in the 2 mg/kg

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NASH NAVIGATE Trial:

Building on the experience of

the NASH-CX trial, the NAVIGATE Trial is a seamless adaptively-designed Phase 2b/3 clinical study evaluating the safety and efficacy of our galectin-3 inhibitor, belapectin, for the prevention of esophageal varices in patient with non-alcoholic

steatohepatitis (NASH) cirrhosis.

The major features of this innovative Phase 2b/3 study design are:

i) In patients with NASH cirrhosis and clinical signs of portal hypertension but without esophageal varices at baseline, this trial will assess

the effect of belapectin on the incidence of new varices (the primary endpoint) – as well as assessing the effect of belapectin on the incidence of additional clinically significant cirrhosis-related outcomes (a key secondary efficacy

endpoint), (ii) The study targets NASH patients with a clearly identified unmet medical need:

patients with compensated cirrhosis who have clinical signs of portal hypertension and, thus, are at risk of developing esophageal varices, a

potentially life-threatening complication of cirrhosis (bleeding varices are a cause of death in about one-third of cirrhotic patients).

Building on the experience of the NASH-CX trial, the NAVIGATE Trial is a seamless adaptively-designed Phase 2b/3 clinical

study evaluating the safety and efficacy of our galectin-3 inhibitor, belapectin, for the prevention of esophageal varices in patient with non-alcoholic steatohepatitis (NASH) cirrhosis.

The major features of this innovative Phase 2b/3 study

i) In patients with NASH cirrhosis and clinical signs of portal hypertension but without esophageal varices at baseline, this trial will assess the effect of belapectin on the incidence of new varices (the primary endpoint) – as

well as assessing the effect of belapectin on the incidence of additional clinically significant cirrhosis-related outcomes (a key secondary efficacy endpoint), (ii) The study targets NASH patients with a clearly identified unmet medical need:

patients with compensated cirrhosis who have clinical signs of portal hypertension and, thus, are at risk of developing esophageal varices, a potentially life-threatening complication of cirrhosis (bleeding varices are a cause of death in about

one-third of cirrhotic patients).

There is currently no approved treatment for preventing varices in these patients.

In addition, the

development of esophageal varices reflects the progression of hepatic cirrhosis and thus portends the development of other cirrhosis complications such as ascites, hepatic encephalopathy, and liver failure, and (iii) During the first 18 months,

two belapectin dose levels (2 mg/kg LBM and 4 mg/kg LBM) will be compared to placebo (phase 2b).

In addition, the development of esophageal varices reflects the progression of hepatic cirrhosis and thus portends the

development of other cirrhosis complications such as ascites, hepatic encephalopathy, and liver failure, and (iii) During the first 18 months, two belapectin dose levels (2 mg/kg LBM and 4 mg/kg LBM) will be compared to placebo (phase 2b).

Then, at the interim analysis (IA), the best belapectin dose will be selected, based on efficacy and safety, for continued evaluation (Phase 3).

The belapectin dose selected for the phase 2b/3 were based on the analysis of the NASH-CX trial.

Prior belapectin clinical studies have also indicated the good tolerance and safety profile of belapectin with doses of up to 8 mg/kg LBM for up to

52 weeks, an important feature to inform the future risk benefit analysis in patients with NASH cirrhosis.

Prior belapectin clinical studies have also indicated the good tolerance and safety profile of belapectin with doses of up to 8 mg/kg LBM for up to 52 weeks, an important feature to inform the future risk benefit analysis in patients with NASH

The study design provides for a pre-specified interim analysis (IA).

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This will allow us to confirm the underlying assumption regarding the rate of varices development, currently estimated from our prior Phase 2b trial (NASH-CX).

The study design also minimizes invasive testing

requirements, such as the measurement of HVPG or repeated liver biopsies, which we believe are particularly risky in patients with portal hypertension and will facilitate enrollment and retention of patients.

It also provides for a seamless

transition of patients from the Phase 2b component into the phase 3 stage, including the potential addition of new patients.

The trial design preserves the surrogate end-point concepts (development of new varices versus variceal hemorrhage)

previously discussed with FDA.

The study design also minimizes invasive

testing requirements, such as the measurement of HVPG or repeated liver biopsies, which we believe are particularly risky in patients with portal hypertension and will facilitate enrollment and retention of patients.

It also provides for a

seamless transition of patients from the Phase 2b component into the phase 3 stage, including the potential addition of new patients.

The trial design preserves the surrogate end-point concepts (development of new varices versus variceal

hemorrhage) previously discussed with FDA.

We believe that these adaptations taken together are innovative and optimize conduct of the NAVIGATE trial with a clinically relevant primary outcome giving belapectin the best opportunity to show a positive

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Also, NASH non-invasive biomarkers will be evaluated.

To target a population at risk

of developing esophageal varices, patient selection will be based on clinical signs of portal hypertension, including, but not limited to, a low platelet count, an increased spleen size and/or evidence of abdominal collaterals circulation.

To target a population at

risk of developing esophageal varices, patient selection will be based on clinical signs of portal hypertension, including, but not limited to, a low platelet count, an increased spleen size and/or evidence of abdominal collaterals circulation.

The focus and goal of the therapeutic program is to stop the progression of and/or reverse portal hypertension and thereby prevent the development of varices, potentially one of the most immediately

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countries, shutdown orders have also affected the regulatory process to authorize study starts.

Governments and medical facilities have focused their resources for battling the COVID-19 pandemic.

For several reasons, the pandemic makes enrolling

Governments and medical facilities focused their resources for battling the COVID-19 pandemic.

For several reasons, the pandemic made enrolling

patients for the NAVIGATE trial more challenging, including because patients eligible for the NAVIGATE trial have liver cirrhosis and, as such, are at a greater health risk of complications from COVID-19.

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safety of our candidate participants first, as cirrhotic patients with portal hypertension are immune compromised.

We believe that as we continue to emerge from the COVID-19 pandemic, site recruitment and patient enrollment will accelerate and we

have experienced increases in enrollment, particularly in the U.S.

However, we have not seen the enrollment in Europe that we anticipated, and conditions there remain uncertain.

Consequently, we have activated multiple sites in Latin America.

At this time, although enrollment completion is targeted for June 30, 2022, it may require an additional quarter to complete.

We have identified and activated approximately 138 clinical trial sites in 14 countries for the NAVIGATE trial.

As we emerged from the COVID-19 pandemic, site recruitment and patient enrollment accelerated and we experienced increases in

enrollment, particularly in the United States.

However, we did not see the enrollment in Europe that we anticipated, and conditions there remain uncertain.

Consequently, we activated multiple sites in Latin America.

The final patient was

randomized in February 2023, and we expect topline results from the IA in Fall of 2024.

We have activated more than 150 clinical trial sites in 14 countries for the NAVIGATE trial.

Further details on the NAVIGATE trial can be found on www.clinicaltrials.gov under study NCT04365868 and on our NAVIGATE website (navigatenash.com).

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Until dosing and safety profile is further informed in CTP Class B and/or Class C patients, the NAVIGATE trial will enroll only CTP Class A patients.

Further details on this hepatic

impairment study can be found on www.clinicaltrials.gov study NCT04332432.

Further details on this

hepatic impairment study can be found on www.clinicaltrials.gov study NCT04332432.

Cancer Immunotherapy.

We believe there is

potential for galectin inhibition to play a key role in the innovative area of cancer immunotherapy.

We believe there is potential for galectin inhibition to play a key role in the innovative area of cancer immunotherapy.

For example, there have been several recent approvals of drugs that enhance a patient’s immune system to fight cancer.

It is our goal to use

ourgalectin-3 inhibitor to further enhance the immune system function to help the body to fight cancer in a way that complements other approaches to this type of therapy.

This hypothesis is supported by the fact that galectin-3 is expressed at

high levels in multiple types of tumors and their micro-environment, where it fosters the malignant nature of the tumors, and protects the tumors from immune attack by the patient’s own defense mechanism.

Our drug candidates provide a promising

new therapeutic approach to enhance the activity of the immune system against cancer cells.

Preclinical studies have indicated that belapectin enhances the immune response to cancer cells, increased tumor shrinkage and enhanced survival in

immune competent mice with prostate, breast, melanoma and sarcoma cancers when combined with one of the immune checkpoint inhibitors, anti-CTLA-4 or anti-PD-1, or with the immune cell activator anti-OX40.

These preclinical data led to the

filing of two Investigator-sponsored INDs and the initiation of Phase 1B studies of belapectin in combination with Yervoy ® (ipilimumab) in metastatic melanoma and

another phase 1B study in combination with KEYTRUDA (pembrolizumab) in patients with metastatic melanoma and head and neck squamous cell carcinoma.

These studies were conducted under the sponsorship of Providence Portland Medical Center’s Earle

It is our goal to use ourgalectin-3 inhibitor to further enhance the immune system function to help the body

to fight cancer in a way that complements other approaches to this type of therapy.

This hypothesis is supported by the fact that galectin-3 is expressed at high levels in multiple types of tumors and their micro-environment, where it fosters

the malignant nature of the tumors, and protects the tumors from immune attack by the patient’s own defense mechanism.

Our drug candidates provide a promising new therapeutic approach to enhance the activity of the immune system against cancer

Preclinical studies have indicated that belapectin enhances the immune response to cancer cells, increased tumor shrinkage and enhanced survival in immune competent mice with prostate, breast, melanoma and sarcoma cancers when combined

with one of the immune checkpoint inhibitors, anti-CTLA-4 or anti-PD-1, or with the immune cell activator anti-OX40.

These preclinical data led to the filing of two Investigator-sponsored INDs and the initiation of Phase 1B studies of

belapectin in combination with Yervoy ® (ipilimumab) in metastatic melanoma and another phase 1B study in combination with KEYTRUDA (pembrolizumab) in patients with

metastatic melanoma and head and neck squamous cell carcinoma.

These studies were conducted under the sponsorship of Providence Portland Medical Center’s Earle A.

Chiles Research Institute (EACRI).

The phase IB study in combination with Yervoy was rapidly discontinued after the first patients were recruited because of the availability on new treatment in the selected population.

The phase IB study in combination with Yervoy was rapidly discontinued after the first patients were recruited because of the availability of new treatment in the selected population.

Promising results were reported in the Phase 1b trial combining belapectin with pembrolizumab (KEYTRUDA ® ).

When aggregated cohorts are combined, in

advanced melanoma, a 50% objective response rate with belapectin in combination with KEYTRUDA, was documented.

In addition, a 33% response rate was documented in patients with head and neck cancer The results have been published in 2021 in a

highly rated peer reviewed journal (Curti et al.

When aggregated cohorts

are combined, in advanced melanoma, a 50% objective response rate with belapectin in combination with KEYTRUDA, was documented.

In addition, a 33% response rate was documented in patients with head and neck cancer The results have been

published in 2021 in a highly rated peer reviewed journal (Curti et al.

Journal of Immunotherapy of cancer 2021;9:e002371).

There was also a suggestion that the combination of belapectin with pembrolizumab could decrease the

auto-immune side-effect induced by pembrolizumab.

These side-effects, which are directly linked to the mechanism of action of pembrolizumab, can be poorly tolerated and even severe enough to lead to treatment interruption, even if the effect on

the cancer was encouraging.

This is of course, a very frustrating situation for patients who have to discontinue an active treatment but have no other options available to them.

We believe these data, taken together with the observed favorable

safety and tolerability of the combination, provide a rationale to move the belapectin program in oncology forward.

There was also a suggestion that the combination of belapectin with pembrolizumab could decrease the auto-immune

side-effect induced by pembrolizumab.

These side-effects, which are directly linked to the mechanism of action of pembrolizumab, can be poorly tolerated and even severe enough to lead to treatment interruption, even if the effect on the cancer

was encouraging.

This is, a very frustrating situation for patients who have to discontinue an active treatment but have no other options available to them.

We believe these data, taken together with the observed favorable safety and

tolerability of the combination, provide a rationale to move the belapectin program in oncology forward.

Late in 2021, we engaged three noted physicians – Dr.

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The decision is notably based on the lack of available treatments for these patients, the limited number of therapies in development, and the resulting very high medical need.

We are currently working to compile an IND

package with the objective for Galectin Therapeutics to file an IND and are planning a phase 2 trial to be filed with the FDA oncology division.

We filed an IND with FDA and are planning a

phase 2 trial to be filed with the FDA oncology division.

Patents and Proprietary Rights

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We rely on a combination of patent, trademark, trade secret and copyright law and contract restrictions to protect the proprietary aspects of our technologies.

We seek to limit disclosure of our intellectual property

by requiring employees, consultants, and any third parties with access to our proprietary information to execute confidentiality agreements and by restricting access to that information.

We seek to protect our intellectual property by

requiring employees, consultants, and any third parties with access to our proprietary information to execute confidentiality agreements and by restricting access to that information.

In August 2015, we received a notice of allowance from the U.S.

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established kidney fibrosis, chronic lung disease associated with the development of fibrosis and established lung fibrosis.

Claims in this patent include administering pectin-derived compound parenterally to a patient having at least one of the

four aforementioned diseases where the established fibrosis or progression of the fibrosis or cirrhosis is inhibited or slowed down.

Additional specific claims encompass deriving the compound from citrus pectin, apple pectin, soybean hull pectin

or sugar beet pectin with a molecular weight between 2 kDa and 400kDa.

Also covered is the step of administering the modified galacto-rhamnogalacturonan compound in an admixture with a therapeutic agent, where the agent is an antifibrotic

Claims in this patent include administering pectin-derived compound parenterally to a patient having at least one of

the four aforementioned diseases where the established fibrosis or progression of the fibrosis or cirrhosis is inhibited or slowed down.

Additional specific claims encompass deriving the compound from citrus pectin, apple pectin, soybean hull

pectin or sugar beet pectin with a molecular weight between 2 kDa and 400kDa.

Also covered is the step of administering the modified galacto-rhamnogalacturonan compound in an admixture with a therapeutic agent, where the agent is an

antifibrotic compound.

In August 2014, we received a notice of allowance from the U.S.

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Patent and Trademark Office issued patent number 8,658,787 to the Company for its application titled “Galacto-rhamnogalacturonate compositions for the

treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease.” The patent covers the Company’s carbohydrate-based galectin inhibitor compound belapectin for use in patients with fatty liver disease with or without fibrosis or

cirrhosis, providing patent protection through 2031.

or cirrhosis, providing patent protection through 2031.

The major claims are for methods of obtaining galectin inhibitor compounds, obtaining a composition for parenteral or enteral administration in an acceptable pharmaceutical carrier and

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Many of our patents and patent

applications cover composition of matter for complex carbohydrate drugs and/or methods of use for reducing toxicity and enhancing chemotherapeutic drugs by co-administering a polysaccharide with a chemotherapeutic agent or for use in treatment of

The scheduled expiration dates of our United States patents span out to 2034 before considering any potential extensions.

We have corresponding patent applications pending in various territories where we see potential for commercial

The scheduled expiration dates of our many of our United States patents span out to 2034 before considering any potential extensions.

We have corresponding patent applications pending in various territories where we see potential

for commercial interest.

Additionally, we have patent applications in other areas to utilize our carbohydrate-based compounds to treat disease other than cancer.

See “Risk Factors — Risks Related to Our Intellectual Property”.

Our competitive position, in part,

is contingent upon protection of our intellectual property.

Galectin Sciences LLC has 3 granted international patent, 1 international patent allowed, 3 US patent application pending, and 27 foreign applications pending.

Our competitive

position, in part, is contingent upon protection of our intellectual property.

Galectin Sciences LLC has 3 granted U.S.

patents, 11 granted international patents, 2 US patent application pending, and 21 foreign applications pending.

Our primary focus is on the design and testing of agents that target galectins in various in vitro and in vivo systems and that

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The long-term goal of this effort is to identify and develop drug candidates that are highly specific galectin inhibitors which may be formulated for oral administration.

intermediate term goal is the development of small molecule inhibitors of galectin-3 which exhibit activity in in vivo preclinical disease models of fibrosis and cancer in which galectins play a key role.

intermediate term goal is the development of small molecule inhibitors of galectin-3 which exhibit activity in in vivo preclinical disease models of fibrosis and cancer in which galectins play a key

Several patent applications have been filed to protect the various series of compounds discovered by these efforts.

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have developed and will continue to develop relationships with third-parties that have established pharmaceutical manufacturing capabilities and expertise.

We are not a party to any long-term agreement with any of our suppliers and, accordingly,

we have our products manufactured on a purchase-order basis from one of two primary well-known and established pharmaceutical suppliers that meet FDA requirements.

Additionally, belapectin is manufactured as a sterile liquid formulation.

experienced, and may experience in the future, certain delays related to COVID-19 related supply issues with certain components necessary to manufacture belapectin.

We are not a party to any long-term agreement with any of our suppliers and,

accordingly, we have our products manufactured on a purchase-order basis from one of two primary well-known and established pharmaceutical suppliers that meet FDA requirements.

Additionally, belapectin is manufactured as a sterile liquid

We have experienced, and may experience in the future, certain delays related to COVID-19 related supply issues with certain components necessary to manufacture belapectin.

Because our products are in the development stage, we have not created a sales and marketing staff to commercialize pharmaceutical products.

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Phase 2 usually involves trials in a limited patient population to (i) evaluate dosage tolerance and appropriate dosage;

(ii) identify possible adverse effects

and safety risks;

(ii) identify possible adverse

effects and safety risks;

and (iii) evaluate preliminarily the efficacy of the drug for specific indications.

Phase 3 trials usually further evaluate clinical efficacy and test further for safety by using the drug in its final form in an expanded patient

Phase 3 trials usually further evaluate clinical efficacy and test further for safety by using the drug in its final form in an

expanded patient population.

There is no assurance that these trials will be completed within a specified period of time, if at all.

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If the FDA evaluates the NDA and the manufacturing facilities as acceptable, the FDA will generally issue an approval letter.

If the FDA evaluates the NDA

submission or the manufacturing facilities as not acceptable, the FDA will generally outline the deficiencies in the submission and often will request additional testing or information.

If the FDA evaluates the

NDA submission or the manufacturing facilities as not acceptable, the FDA will generally outline the deficiencies in the submission and often will request additional testing or information.

Even if an applicant submits the requested additional

information, the FDA ultimately may decide that the NDA does not satisfy the regulatory criteria for approval.

The testing and approval process require substantial time, effort, and financial resources, and there is no assurance that any approval

will be granted on a timely basis, if at all.

The testing and approval process require substantial time, effort, and financial resources, and there is no assurance that any

approval will be granted on a timely basis, if at all.

After approval, certain changes to the approved product, such as adding new indications, manufacturing changes, or additional labeling claims are subject to further FDA review and approval.

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trials, product licensing, pricing and reimbursement vary widely from country to country.

No action can be taken to market any product in a country until an appropriate application has been approved by the regulatory authorities in that country.

No action can be taken to market any product in a country until an appropriate application has been approved by the regulatory authorities in that

The current approval process varies from country to country, and the time spent in gaining approval varies from that required for FDA approval.

In certain countries, the sales price of a product must also be approved.

The pricing review period

often begins after market approval is granted.

review period often begins after market approval is granted.

No assurance can be given that even if a product is approved by a regulatory authority, satisfactory prices will be approved for such product.

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Human Capital Resources

As of February 28, 2022, we currently have nine full-time employees, six of whom are involved primarily in management of our pre-clinical research and development and clinical trials and three who were involved

As of February 28, 2023, we currently have twelve full-time employees, nine of whom are involved primarily in management of our pre-clinical research and development and clinical trials and three who were involved

primarily in management and administration of our Company.

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websites is not a part of, nor is it incorporated by reference into, this Annual Report on Form 10-K.

An investment in our common stock involves a high degree of risk.

You should carefully consider the risks described below and the other information before deciding to invest in our common stock.

The risks described

below are not the only ones facing our Company.

Additional risks not presently known to us or that we currently consider immaterial may also adversely affect our business.

We have attempted to identify below the major factors that could cause

differences between actual and planned or expected results, but we cannot assure you that we have identified all of those factors.

If any of the following risks actually happen, our business, financial condition and operating results could be materially adversely affected.

In this case, the trading price of our common stock could decline, and

you could lose all or part of your investment.

Risks Related to Our Company

We have incurred net losses to date and must raise additional capital in order to continue to operate.

We have incurred net losses in each year of operation since our inception in July 2000 and have no revenues.

Our accumulated deficit as of December 31, 2022 was $310 million.

We had $18.6 million of unrestricted

cash as of December 31, 2022 and $50 million available under a line of credit provided by our chairman, Richard E.

The Company believes there is sufficient cash to fund currently planned operations at least through December 31, 2024.

We will require more cash to fund our operations after December 31, 2024 and believe we will be able to obtain additional financing.

However, there can be no assurance that we will be successful in obtaining such new financing or, if available,

that such financing will be on terms favorable to us.

We may raise capital through public or private equity financings, partnerships, debt financings, bank borrowings, or other sources.

Additional funding may not be available on favorable terms or at all.

Though his investments in the Company,

Uihlein has been a critical source of funding via equity and debt financings.

There is no assurance as to the level of future investments to be made in the Company by Mr.

If adequate funds are not otherwise available, we may need

to significantly curtail operations.

To obtain additional funding, we may need to enter into arrangements that require us to relinquish rights to certain technologies, products and/or potential markets.

To the extent that additional capital is

raised through the sale of equity, or securities convertible into equity, our equity holders may experience dilution of their proportionate ownership of the Company.

We are a development stage company and have not yet generated any revenue.

We are a development stage company and have not generated any revenues to date.

There is no assurance that we will obtain FDA approval of belapectin or other products that we may develop, and, even if we do so, that we will generate revenue

sufficient to become profitable.

Our failure to generate revenue and profit would likely lead to loss of your investment.

Our ability to generate revenue from product sales and achieve profitability will depend upon our ability to successfully commercialize products, including our lead product candidate, or other product candidates

that we may in-license or acquire in the future.

Even if we are able to successfully achieve regulatory approval for these product candidates, we do not know when any of these products will generate revenue from product sales for us, if at all.

Our ability to generate revenue from product sales from our current or future product candidates also depends on a number of additional factors, including our ability to:

successfully complete development activities, including the necessary clinical trials;

complete and submit new drug applications, or NDAs, to the U.S.

Food and Drug Administration, or FDA, and obtain regulatory approval for indications for which there is a commercial market;

complete and submit applications to, and obtain regulatory approval from, foreign regulatory authorities;

successfully complete all required regulatory agency inspections;

set a commercially viable price for our products;

obtain commercial quantities of our products at acceptable cost levels;

find suitable distribution partners to help us market, sell and distribute our approved products in other markets;

obtain coverage and adequate reimbursement from third parties, including government and private payers.

In addition, because of the numerous risks and uncertainties associated with product development, including that our product candidates may not advance through development or achieve the

endpoints of applicable clinical trials, we are unable to predict the timing or amount of increased expenses, or when or if we will be able to achieve or maintain profitability.

Even if we are able to complete the development and regulatory

process for any product candidates, we anticipate incurring significant costs associated with commercializing these products.

If we are unable to generate revenues from the sale of our products, we may not become profitable and may need to obtain additional funding to continue operations.

If we fail to become

profitable or are unable to sustain profitability on a continuing basis, then we may be unable to continue our operations at planned levels and be forced to reduce our operations.

We are dependent on the success of our lead product candidate, belapectin, and we cannot be certain that our product candidates will receive regulatory approval or be

successfully commercialized.

We currently have no products for sale, and we cannot guarantee that we will ever have any drug products approved for sale.

We and our product candidates are subject to extensive regulation by the FDA and comparable regulatory authorities in

other countries governing, among other things, research, testing, clinical trials, manufacturing, labeling, promotion, selling, adverse event reporting and recordkeeping.

We are not permitted to market any of our product candidates in or

outside the United States until we receive approval of a new drug application for a product candidate from the FDA or the equivalent approval from a foreign regulatory authority.

Obtaining FDA approval is a lengthy, expensive and uncertain

Before obtaining regulatory approval for the sale of any drug candidate, we must conduct extensive pre-clinical studies and clinical trials to demonstrate the safety and efficacy of our product candidates in humans.

To obtain FDA approval, we will need to conduct one or more Phase 3 clinical trial for belapectin;

however, we cannot assure you that we will be able to finance Phase 3 trials.

Additionally, we cannot assure you

that our future trials will yield successful results, that they will lead to the generation of revenue, or that we will obtain regulatory approval in other countries.

Pre-clinical studies and clinical trials are expensive, time-consuming and ultimately may not be successful.

The results of pre-clinical and initial clinical testing of these products may not necessarily indicate

the results that will be obtained from later or more extensive testing.

Also, it is possible to suffer significant setbacks in advanced clinical trials, even after obtaining promising results in earlier trials.

For example, although there was

positive data from our NASH-CX Phase 2 trial for belapectin, it did not meet its primary endpoint.

Similarly, our Phase 2a pilot trial NASH-FX for patients with advanced fibrosis, which explored three non-invasive imaging technologies, did not

meet its primary endpoint.

We may engage others to conduct our clinical trials, including clinical research organizations and, possibly, government-sponsored agencies.

Additional clinical trials may not start or be completed as we forecast and

may not achieve the desired results.

The time required to obtain FDA and other approvals is unpredictable but often can take years following the commencement of clinical trials, depending upon the complexity of the drug candidate.

Difficulty and delays in enrolling patients and registering sites for conducting clinical trials may prevent or delay product development and strain our limited financial

There are other life sciences companies conducting clinical trials in patients with the disease indications that our product candidates target.

As a result, we must compete with them for clinical sites, physicians

and the limited number of patients who fulfill the stringent requirements for participation in clinical trials.

Also, due to the confidential nature of clinical trials, we do not know how many of the eligible patients may be enrolled in

competing studies and who are consequently not available to us for our clinical trials.

In addition, our clinical trials have been affected by and may continue to be affected by the COVID-19 pandemic.

Clinical site initiation and patient enrollment as well as availability of certain required lab kits

for our non-COVID-19 product candidates have been and may continue to be delayed due to prioritization of hospital resources toward the COVID-19 pandemic.

Some patients have not been and others may not want or be able to comply with clinical

trial protocols if quarantines impede patient movement or interrupt healthcare services.

Similarly, any inability to recruit and retain patients and principal investigators and site staff who, as healthcare providers, may have heightened

exposure to COVID-19, may adversely impact our clinical trial operations.

Patient enrollment depends on many factors, including the size of the patient population, the nature of the trial protocol, the proximity of patients to clinical sites, the eligibility criteria for the study and

potential reduced enrollment due to the COVID-19 pandemic.

The delay or inability to meet planned patient enrollment may result in increased costs and delays or termination of the trial, which could have a harmful effect on our ability to

develop products.

Even if we receive regulatory approval, we may be unable to commercialize our product candidates.

Even if belapectin and other future product candidates achieve positive results in clinical trials, we may be unable to commercialize them.

The availability of government and third-party payer reimbursement, and

pricing, especially compared to competitor products, could affect our ability to commercialize our product candidates.

Our general inability to obtain necessary regulatory approvals and, if obtained, to commercialize our products would

substantially impair our viability.

There are risks associated with our reliance on third parties to design trial protocols, arrange for and monitor the clinical trials, and collect and analyze data.

As we develop products eligible for clinical trials, we will contract with independent parties to assist us in the design of the trial protocols, arrange for and

monitor the clinical trials, provide lab kits, collect data and analyze data and samples.

In addition, certain clinical trials for our products may be conducted by government-sponsored agencies

and will be dependent on governmental participation and funding.

We have contracted with a third party, Covance, for assistance with the design and conduct of our NAVIGATE trial.

Our dependence on independent parties and clinical sites involves risks including reduced control over the timing and other aspects of our clinical trials.

There are risks associated with our reliance on third parties for manufacturing belapectin.

We do not have, and do not now intend to develop, facilities for the manufacture of any of our products, including belapectin, for clinical or commercial production.

At this time, we are not a party to any long-term agreement with any of our

suppliers, and accordingly, we have our products manufactured on a purchase-order basis from one of two primary suppliers.

We are developing relationships with manufacturers and will enter into collaborative arrangements with licensees or have

others manufacture our products on a contract basis.

We expect to depend on such collaborators to supply us with products manufactured in compliance with standards imposed by the FDA and foreign regulators.

We are exposed to pre-clinical and clinical liability risks which could place a financial burden upon us, should we be sued, because we do not currently have product liability

insurance beyond our general insurance coverage.

Our business exposes us to potential pre-clinical, clinical liability and other liability risks that are inherent in the testing pharmaceutical formulations and products;

accordingly, claims may be asserted against

In addition, the use in our clinical trials of pharmaceutical formulations and products that our potential collaborators may develop and the subsequent sale of such formulations or products by us or our potential collaborators may cause us

to assume a portion of or all of the product liability risks.

A successful liability claim or series of claims brought against us could have a material adverse effect on our business, financial condition and results of operations.

Because we do

not currently have any FDA-approved products or formulations, we do not currently have any product liability insurance covering commercialized products.

Our current and potential partners with whom we have collaborative agreements or our future

licensees may not be willing to indemnify us against these types of liabilities and may not, themselves, be sufficiently insured or have sufficient liquidity to satisfy any product liability claims.

Claims or losses in excess of any insurance

coverage that may be obtained by us could have a material adverse effect on our business, financial condition and results of operations.

We face intense competition in the biotechnology and pharmaceutical industries.

The biotechnology and pharmaceutical industries are intensely competitive.

We face direct competition from U.S.

and foreign companies focusing on pharmaceutical products, which are rapidly evolving.

competitors include major multinational pharmaceutical and chemical companies, specialized biotechnology firms and universities and other research institutions.

Many of these competitors possess greater financial and other resources, larger

research and development staffs and more effective marketing and manufacturing organizations than we possess.

In addition, academic and government institutions are increasingly likely to enter into exclusive licensing agreements with commercial

enterprises, including our competitors, to market commercial products based on technology developed at such institutions.

Our competitors may succeed in developing or licensing technologies and products that are more effective or succeed in

obtaining FDA or other regulatory approvals for product candidates before we do.

Acquisitions of, or investments in, competing pharmaceutical or biotechnology companies by large corporations could increase such competitors’ financial,

marketing, manufacturing and other resources.

The market for our proposed products is rapidly changing and competitive, and new drugs and new treatments that may be developed by others could impair our ability to maintain

and grow our business and remain competitive.

The pharmaceutical and biotechnology industries are subject to rapid and substantial technological change.

Developments by others may render our proposed products noncompetitive or obsolete, or we may be unable to

keep pace with technological developments or other market factors.

Technological competition from pharmaceutical and biotechnology companies, universities, governmental entities and others diversifying into the field is intense and is expected

Our resources are limited and we may experience technical challenges inherent in such technologies.

Our competitors may develop drugs that are safer, more effective and less costly than our proposed products and, therefore, present

a serious competitive threat to us.

The potential widespread acceptance of therapies that are alternatives to ours may limit market acceptance of our proposed products, even if commercialized.

Some of our targeted diseases and conditions may also be

treated by other medications.

These treatments may be widely accepted in medical communities and have a longer history of use.

The established use of these competitive drugs may limit the potential for our technologies, formulations and

products to receive widespread acceptance even if commercialized.

Our lack of operating experience may cause us difficulty in managing our growth.

We have limited experience in manufacturing or procuring products in commercial quantities, conducting other later-stage phases of the regulatory approval process, selling pharmaceutical products, and negotiating,

establishing and maintaining strategic relationships.

Although we may engage consultants to assist us, any additional growth may require us to expand our management, operational and financial systems and controls.

If we are unable to do so, our

business and financial condition would be materially harmed.

If rapid growth occurs, it may strain our managerial, operational and financial resources.

We depend on key individuals to develop our products and core technologies and pursue collaborative relationships.

We are highly dependent on our current base of a few employees and external consultants.

These individuals, among other things, design and lead our pre-clinical and clinical studies, as well as our U.S.

European regulatory processes.

With little or no redundancy in our personnel, the loss of any personnel or failure to attract or retain other key personnel and consultants could result in a loss of experience and accumulated knowledge and

prevent us from developing our products and core technologies and pursuing collaborative relationships.

We may fail to comply with our reporting and other requirements under federal securities laws.

As a publicly traded company, we are subject to the reporting requirements of the Exchange Act.

The Exchange Act requires that we file annual, quarterly and current reports.

Our failure to prepare and disclose this information in a timely

manner could subject us to penalties under federal securities laws, expose us to lawsuits and restrict our ability to access financing.

We may be required to implement additional and expensive finance and accounting systems, procedures and

controls as we grow our business and organization to satisfy new reporting requirements, which will increase our costs and require additional management resources.

Our long-term success is dependent not only upon the success of our trials but also upon us being able to capitalize upon potential positive results of our trials, which is

To conduct Phase 3 clinical trials or other clinical trials we will need sufficient cash resources to conduct those undertakings.

We will also need to obtain sufficient dosages of belapectin for such trials.

Manufacturing of belapectin is performed by third parties on a contract basis and production is ongoing to generate what we believe are sufficient quantities of belapectin for our NAVIGATE or other clinical trials.

Manufacturing could become

delayed due to circumstances beyond our control which could delay any clinical trials.

Further because of limited resources, we have curtailed most of our expenditures in research focused on the development of an oral galectin inhibitor to

replace our current drug candidate that is delivered via infusion.

We have previously been a defendant in a shareholder derivative action, and any possible future such lawsuits may adversely affect our business, financial condition, results

of operations and cash flows.

We and certain of our officers and directors have previously been defendants in a state court shareholder derivative action that concluded in our favor.

In addition, there is the potential for other future shareholder litigation and for

governmental investigations and/or enforcement actions.

Similar lawsuits in the future may divert our attention from our ordinary business operations, and we may incur significant expenses associated with their defense (including, without

limitation, substantial attorneys’ fees and other fees of professional advisors and potential obligations to indemnify current and former officers and directors who are or may become parties to such actions).

If similar lawsuits do arise in the

future, we may be required to pay material damages and fines, consent to injunctions on future conduct and/or suffer other penalties, remedies or sanctions.

Accordingly, the ultimate resolution of these matters could have a material adverse

effect on our business, results of operations, financial condition, liquidity and ability to meet any debt obligations and, consequently, could negatively impact the trading price of our common stock.

Any existing or future shareholder lawsuits

and any future governmental investigations and/or enforcement actions could adversely impact our reputation, our relationships with our customers and our ability to generate revenue.

Risks Related to the Regulation of our Products

We will need regulatory approvals to commercialize our products.

We are required to obtain approval (i) from the FDA in order to sell our products in the U.S.

and (ii) from foreign regulatory authorities in order to sell our products in other countries.

The FDA’s review and

approval process is lengthy, expensive and uncertain.

Extensive pre-clinical and clinical data and supporting information must be submitted to the FDA for each indication for each product candidate in order to secure FDA approval.

receiving FDA clearance to market our proposed products, we will have to demonstrate that our products are safe on the patient population and effective for the diseases that are to be treated.

Clinical trials, manufacturing and marketing of

drugs are subject to the rigorous testing and approval process of the FDA and equivalent foreign regulatory authorities.

FDA may change, at any time, its requirements for approval of new drugs based on information and data received from others

and ourselves potentially resulting in product approval delays or non-approvals.

The Federal Food, Drug and Cosmetic Act and other federal, state and foreign statutes and regulations govern and influence the testing, manufacture, labeling,

advertising, distribution and promotion of drugs and medical devices.

As a result, regulatory approvals can take several years to acquire and may further require the expenditure of substantial financial, managerial and other resources.

could reject an application or, in the alternative, require us to conduct additional clinical or other studies as part of the regulatory review process.

Delays in obtaining or failure to obtain FDA approvals would delay or prevent the

commercialization of our product candidates, which would prevent, defer or decrease our receipt of revenues.

In addition, should we receive initial regulatory approval, our product candidates will be subject to extensive and rigorous ongoing

domestic and foreign government regulation.

Even if we obtain regulatory approvals, our marketed drugs will be subject to ongoing regulatory review.

If we fail to comply with ongoing regulatory requirements, we could

lose our approvals to market drugs, in which case our business would be materially adversely affected.

Following regulatory approval in the United States of any drugs we may develop, we will remain subject to continuing regulatory review, including the review of adverse drug experiences and clinical results that are

reported after our drug products are made available to patients.

This would include results from any post marketing tests or vigilance required as a condition of approval.

The manufacturer and manufacturing facilities we use to make any of our

drug products will also be subject to periodic review and inspection by the FDA.

The discovery of any new or previously unknown problems with the product, manufacturer or facility may result in restrictions on the drug, manufacturer or

facility, including withdrawal of the drug from the market.

We would continue to be subject to the FDA requirements governing the labeling, packaging, storage, advertising, promotion, recordkeeping, and submission of safety and other

post-market information for all of our product candidates, even those that the FDA had approved.

If we fail to comply with applicable continuing regulatory requirements, we may be subject to fines, suspension or withdrawal of regulatory

approval, product recalls and seizures, operating restrictions and other adverse consequences.

The drug development process to obtain FDA approval is very costly and time consuming, and if we cannot complete our clinical trials in a cost-effective manner, our results

of operations may be adversely affected.

Costs and timing of clinical trials may vary significantly over the life of a project owing to the following non-exclusive reasons:

the duration of the clinical trials;

the number of sites included in the trials;

the countries in which the trial is conducted;

the length of time required and ability to enroll eligible patients;

the number of patients that participate in the trials;

the number of doses that patients receive;

the drop-out or discontinuation rates of patients;

per patient trial costs;

third party contractors failing to comply with regulatory requirements or meet their contractual obligations to us in a timely manner;

our drug product candidates having different chemical and pharmacological properties in humans than in lab testing;

the need to suspend or terminate our clinical trials;

insufficient or inadequate supply or quality of drug product candidates or other necessary materials to conduct our trials;

potential additional safety monitoring, or other conditions required by FDA or comparable foreign regulatory authorities regarding the scope or design of our clinical trials, or other studies requested by regulatory agencies;

problems engaging IRBs to oversee trials or in obtaining and maintaining IRB approval of studies;

the duration of patient follow-up;

the efficacy and safety profile of the product candidate;

the costs and timing of obtaining regulatory approvals;

the costs involved in enforcing or defending patent claims or other intellectual property rights.

Each of the above factors and other unanticipated factors beyond our control could prevent us from gaining approval for our drugs in a cost-effective and timely manner, which could have a material adverse impact

on our business.

Data obtained from clinical trials are not necessarily predictive of future results, may be negative or inconclusive, and are susceptible to varying interpretations, which

could delay, limit or prevent regulatory clearances.

Data already obtained, or in the future obtained, from pre-clinical studies and clinical trials do not necessarily predict the results that will be obtained from later pre-clinical studies and clinical trials.

Moreover, pre-clinical and

clinical data may be negative or inconclusive.

In addition, data is susceptible to varying interpretations.

Negative or inconclusive data, or data interpreted in various ways, could delay, limit or prevent regulatory approval.

companies in the pharmaceutical industry have suffered significant setbacks in advanced clinical trials, even after they obtained promising results in earlier trials.

Despite the results reported in some of our earlier clinical trials for

belapectin, our clinical trials may not demonstrate sufficient levels of safety and efficacy necessary to obtain the requisite regulatory approvals for our drugs, and thus, our proposed drugs may not be approved for marketing.

If later-stage

clinical trials do not produce favorable results, our ability to achieve regulatory approval for any of our product candidates may be adversely impacted.

The failure to adequately demonstrate the safety and effectiveness of a proposed

formulation or product under development could delay or prevent regulatory clearance of the potential drug.

The resulting delays in commercialization could materially harm our business.

Our product candidates may cause undesirable side effects or have other properties that could delay or prevent their regulatory approval, limit the commercial profile of an

approved label, or result in significant negative consequences following any marketing approval.

Undesirable side effects caused by our product candidates could cause us or regulatory authorities to interrupt, delay or halt clinical trials and could result in a more restrictive label or

the delay or denial of regulatory approval by the FDA or other comparable foreign regulatory authority.

Although we are not currently aware of any undesirable side effects caused by our product candidates, it is possible that they may be

identified in the clinical trial process.

As a result of undesirable side effects or safety or toxicity issues that we may experience in our clinical trials, we may not receive approval to market any product candidates, which could prevent us from ever

generating revenues or achieving profitability.

Results of our trials could reveal an unacceptably high severity and prevalence of side effects.

In such an event, our trials could be suspended or terminated, and the FDA or comparable foreign

regulatory authorities could order us to cease further development or deny approval of our product candidates for any or all targeted indications.

These side effects could affect patient recruitment or the ability of enrolled subjects to

complete the trial or result in potential product liability claims.

Additionally, if any of our product candidates receives marketing approval, and we or others later identify undesirable side effects caused by such product, a number of potentially significant negative consequences

could result, including:

we may be forced to suspend marketing of such product;

regulatory authorities may withdraw their approvals of such product;

regulatory authorities may require additional warnings on the label that could diminish the usage or otherwise limit the commercial success of such products;

we may be required to conduct post-market studies;

we could be sued and held liable for harm caused to subjects or patients;

our reputation may suffer.

Any of these events could prevent us from achieving or maintaining market acceptance of the particular product candidate, if approved.

Failure to obtain regulatory approval in international jurisdictions would prevent our product candidates from being marketed abroad.

In order to market and sell our products in the European Union and many other jurisdictions, we must obtain separate marketing approvals and comply with numerous and varying regulatory requirements.

The approval procedure varies among

countries and can involve additional testing.

The time required to obtain approval may differ substantially from that required to obtain FDA approval.

The regulatory approval process outside the United States generally includes all of the risks

associated with obtaining FDA approval.

In addition, in many countries outside the United States, it is required that the product be approved for reimbursement before the product can be approved for sale in that country.

We may not obtain

approvals from regulatory authorities outside the United States on a timely basis, if at all.

Approval by the FDA does not ensure approval by regulatory authorities in other countries or jurisdictions, and approval by one regulatory authority

outside the United States does not ensure approval by regulatory authorities in other countries or jurisdictions or by the FDA.

We may not be able to file for marketing approvals and may not receive necessary approvals to commercialize our

products in any market.

If we are unable to obtain approval of any of our product candidates by regulatory authorities in the European Union or other countries, the commercial prospects of that product candidate may be significantly diminished,

and our business prospects could decline.

Risks Related to Our Intellectual Property

Our competitive position is contingent upon the protection of our intellectual property.

Development and protection of our intellectual property are critical to our business.

All of our intellectual property, patented or otherwise, has been invented and/or developed by employees or former employees of

Our success depends, in part, on our ability to obtain patent protection for our products or processes in the U.S.

and other countries, protect trade secrets and prevent others from infringing on our proprietary rights.

only be able to protect our product candidates from unauthorized making, using, selling, offering to sell or importation by third parties to the extent that we have rights under valid and enforceable patents or trade secrets that cover these

If we do not adequately protect our intellectual property, competitors may be able to practice our technologies.

The patent positions of pharmaceutical and biotechnology companies can be highly uncertain and involve complex legal and factual questions for which important legal principles remain unresolved.

No consistent

policy regarding the breadth of claims allowed in biotechnology patents has emerged to date in the United States.

The biotechnology patent situation outside the United States is even more uncertain.

Changes in either the patent laws or in

interpretations of patent laws in the United States and other countries may diminish the value of our intellectual property.

Accordingly, we cannot predict the breadth of claims that may be allowed in our pending patent applications or enforced

in our issued patents or in third-party patents.

The degree of future protection for our proprietary rights is uncertain because legal means afford only limited protection and may not adequately protect our rights or permit us to gain or keep our competitive

others may be able to make compounds that are competitive with our product candidates but are not covered by the claims of our patents;

we might not have been the first to make the inventions covered by our pending patent applications;

we might not have been the first to file patent applications for these inventions;

it is possible that our pending patent applications will not result in issued patents;

we may not develop additional proprietary technologies that are patentable;

the patents of others may have an adverse effect on our business.

We also may rely on trade secrets to protect our technology, especially where we do not believe patent protection is appropriate or obtainable.

However, trade secrets are difficult to protect.

Although we require

our scientific and technical employees and consultants to enter into broad assignment of inventions agreements, and all of our employees, consultants and corporate partners with access to proprietary information to enter into confidentiality

agreements, these agreements may not be honored.

Enforcing a claim that a third party illegally obtained, and is using, our trade secrets is expensive and time consuming, and the outcome is unpredictable.

In addition, courts outside the United

States are sometimes less willing to protect trade secrets.

Moreover, our competitors may independently develop equivalent knowledge, methods and know-how.

We may incur substantial costs as a result of litigation or other proceedings relating to patent and other intellectual property rights, and we may be unable to protect our

rights to, or use of, our technology.

Some or all of our patent applications may not issue as patents, or the claims of any issued patents may not afford meaningful protection for our technologies or products.

In addition, patents issued to us or our licensors, if any, may be

challenged and subsequently narrowed, invalidated or circumvented.

Patent litigation is widespread in the biotechnology industry and could harm our business.

Litigation might be necessary to protect our patent position or to determine the scope

and validity of third-party proprietary rights.

If we choose to go to court to stop someone else from using the inventions claimed in our patents, that individual or company would have the right to ask the court to rule that such patents are invalid and/or

should not be enforced against that third party.

These lawsuits are expensive, and we may not have the required resources to pursue such litigation or to protect our patent rights.

In addition, there is a risk that the court will decide that

these patents are not valid and that we do not have the right to stop the other party from using the inventions.

There is also the risk that, even if the validity of these patents is upheld, the court will refuse to stop the other party on the

ground that such other party’s activities do not infringe our rights in these patents.

Furthermore, a third party may claim that we are using inventions covered by the third party’s patent rights and may go to court to stop us from engaging in our normal operations and activities, including making or selling our product

These lawsuits are costly and could affect our results of operations and divert the attention of managerial and technical personnel.

There is a risk that a court would decide that we are infringing the third party’s patents and

would order us to stop the activities covered by the patents.

In addition, there is a risk that a court will order us to pay the other party treble damages for having violated the other party’s patents.

The biotechnology industry has produced a

proliferation of patents, and it is not always clear to industry participants, including us, which patents cover various types of products or methods of use.

The coverage of patents is subject to interpretation by the courts, and the

interpretation is not always uniform.

If we are sued for patent infringement, we would need to demonstrate that our products or methods of use either do not infringe the claims of the relevant patent and/or that the patent claims are invalid,

and we may not be able to do this.

Proving invalidity in the U.S., in particular, is difficult since it requires a showing of clear and convincing evidence to overcome the presumption of validity enjoyed by issued patents.

Because some patent applications in the United States may be maintained in secrecy until the patents are issued, patent applications in the United States and many foreign jurisdictions are typically not published until eighteen months after

filing, and publications in the scientific literature often lag behind actual discoveries, we cannot be certain that others have not filed patent applications for technology covered by our issued patents or our pending applications or that we

were the first to invent the technology.

Our competitors may have filed, and may in the future file, patent applications covering technology similar to ours.

Any such patent application may have priority over our patent applications and could

further require us to obtain rights to issued patents covering such technologies.

If another party has filed a United States patent application on inventions similar to ours, we may have to participate in an interference or other proceeding in

the PTO or a court to determine priority of invention in the United States.

The costs of these proceedings could be substantial, and it is possible that such efforts would be unsuccessful, resulting in a loss of our United States patent

position with respect to such inventions.

Some of our competitors may be able to sustain the costs of complex patent litigation more effectively than we can because they have substantially greater resources.

In addition, any

uncertainties resulting from the initiation and continuation of any litigation could have a material adverse effect on our ability to raise the funds necessary to continue our operations.

Obtaining and maintaining our patent protection depends upon compliance with various procedural, document submission, fee payment and other requirements imposed by

governmental patent agencies, and our patent protection could be reduced or eliminated for non-compliance with these requirements.

The PTO and various foreign governmental patent agencies require compliance with a number of procedural, documentary, fee payment and other provisions during the patent process.

There are situations in which

noncompliance can result in abandonment or lapse of a patent or patent application, resulting in partial or complete loss of patent rights in the relevant jurisdiction.

In such an event, competitors might be able to enter the market earlier

than would otherwise have been the case.

Our failure to secure trademark registration could adversely affect our ability to market our product candidates and our business.

Our trademark applications in the United States, when filed, and any other jurisdictions where we may file may not be allowed for registration, and our registered trademarks may not be maintained or enforced.

During trademark registration proceedings, we may receive rejections.

Although we are given an opportunity to respond to those rejections, we may be unable to overcome such rejections.

In addition, in the PTO and in comparable agencies in many

foreign jurisdictions, third parties are given an opportunity to oppose pending trademark applications and to seek to cancel registered trademarks.

Opposition or cancellation proceedings may be filed against our applications and/or

registrations, and our applications and/or registrations may not survive such proceedings.

Failure to secure such trademark registrations in the United States and in foreign jurisdictions could adversely affect our ability to market our product

candidates and our business.

Confidentiality agreements with employees and others may not adequately prevent disclosure of our trade secrets and other proprietary information and may not adequately

protect our intellectual property, which could impede our ability to compete.

Because we operate in the highly technical field of biotechnology and pharmaceutical development, we rely in part on trade secret protection in order to protect our proprietary trade secrets and unpatented

However, trade secrets are difficult to protect, and we cannot be certain that others will not develop the same or similar technologies on their own.

We have taken steps, including entering into confidentiality agreements with all of

our employees, consultants and corporate partners to protect our trade secrets and unpatented know-how.

These agreements generally require that the other party keep confidential and not disclose to third parties all confidential information

developed by the party or made known to the party by us during the course of the party’s relationship with us.

We also typically obtain agreements from these parties that provide that inventions conceived by the party in the course of rendering

services to us will be our exclusive property.

However, these agreements may not be honored and may not effectively assign intellectual property rights to us.

Enforcing a claim that a party illegally obtained and is using our trade secrets or

know-how is difficult, expensive and time consuming, and the outcome is unpredictable.

In addition, courts outside the United States may be less willing to protect trade secrets or know-how.

The failure to obtain or maintain trade secret

protection could adversely affect our competitive position.

We may be subject to claims that our employees have wrongfully used or disclosed alleged trade secrets of their former employers.

As is common in the biotechnology and pharmaceutical industry, we employ individuals who were previously employed at other biotechnology or pharmaceutical companies, including our competitors or potential competitors.

Although no claims

against us are currently pending, we may be subject to claims that these employees or we have inadvertently or otherwise used or disclosed trade secrets or other proprietary information of their former employers.

Litigation may be necessary to

defend against these claims.

Even if we are successful in defending against these claims, litigation could result in substantial costs and be a distraction to management.

Risks Related to Information Technology and Cybersecurity

We are dependent on information technology and our systems and infrastructure face certain risks, including from cybersecurity breaches and data leakage.

We rely extensively on information technology systems, networks and services that are managed and hosted provided by third-parties or their vendors, to assist in conducting our business.

A significant breakdown,

invasion, corruption, destruction or interruption of critical information technology systems or infrastructure, by our personnel or others with authorized access to our systems or unauthorized persons could negatively impact our operations.

ever-increasing use and evolution of technology, including cloud-based computing, creates opportunities for the unintentional dissemination or intentional destruction or modification of confidential information stored in our, or our third-party

providers’ systems, portable media or storage devices.

We could also experience a business interruption, theft of confidential information or reputational damage from malicious cyber-attacks, which may compromise our system infrastructure or

lead to data leakage, either internally or at our third-party providers.

As the COVID-19 pandemic continues to progress, we have observed an increase in cybersecurity incidents across the industry, predominantly ransomware and social

engineering attacks.

As the cyber-threat landscape evolves, these attacks are growing in frequency, sophistication and intensity, and due to the nature of some of these attacks, there is also a risk that they may remain undetected for a period

There can be no assurance that we will be able to prevent breakdowns or breaches to our or our third-party providers’ databases or systems that could adversely affect our business.

Risks Related to Our Common Stock

The market price of our common stock may be volatile and adversely affected by several factors.

This could subject us to securities class action litigation, and our

stockholders could incur substantial losses.

The market price of our common stock could fluctuate significantly in response to various factors and events, including but not limited to:

the results of our pre-clinical studies and clinical trials, including interim results, as well as those of our competitors;

regulatory actions with respect to our products or our competitors’ products;

our ability to integrate operations, technology, products and services;

our ability to execute our business plan;

operating results below expectations;

our issuance of additional securities, including debt or equity or a combination thereof, which may be necessary to fund our operating expenses and the cost of our clinical trials;

announcements of technological innovations or new products by us or our competitors;

the success of competitive products;

loss of any strategic relationship;

industry developments, including, without limitation, changes in healthcare policies or practices or third-party reimbursement policies;

regulatory or legal developments in the United States and other countries;

the level of expenses related to any of our product candidates or clinical development programs;

disputes or other developments related to proprietary rights, including patents, litigation matters, and our ability to obtain patent protection for our technologies;

economic and other external factors;

period-to-period fluctuations in our financial results;

sales of our common stock by us, our insiders or our other stockholders;

whether an active trading market in our common stock develops and is maintained;

engagement and retention of senior management needed for our clinical trials;

novel and unforeseen market forces and trading strategies, such as the massive short squeeze rally caused by retail investors on companies such as Gamestop.

In addition, the market price for securities of pharmaceutical and biotechnology companies historically has been highly volatile, and the securities markets have from time-to-time experienced significant price and

volume fluctuations that are unrelated to the operating performance of particular companies.

These broad market fluctuations may cause the market price of our common stock to decline substantially.

In the past, securities class action litigation has often been brought against a company, including us, following a decline in the market price of its securities.

This risk is especially relevant for us because

biotechnology and biopharmaceutical companies have experienced significant stock price volatility in recent years.

As described above, we have recently defended a consolidated federal securities class action lawsuit and a consolidated

shareholder derivative actions, and we may become involved in additional instances of this type of litigation in the future.

Litigation often is expensive and diverts management’s attention and resources, which could materially and adversely

affect our business.

Additionally, fluctuations in the trading price or liquidity of our common stock may materially and adversely affect, among other things, the interest of investors to purchase our common stock on the open market

and, generally, our ability to raise capital.

Our board of directors has the power to designate, without stockholder approval, additional series of preferred capital, the shares of which could be senior to our common

stock and be entitled to conversion or voting rights that adversely affect the holders of our common stock.

Our articles of incorporation authorize the issuance of capital stock including 20,000,000 authorized undesignated shares (all have been designated as of December 31, 2022), and empowers our

board of directors to prescribe, by resolution and without stockholder approval, a class or series of undesignated shares, including the number of shares in the class or series and the voting powers, designations, rights, preferences,

restrictions and the relative rights in each such class or series.

Accordingly, in the event that additional undesignated shares are authorized under our charter documents, our board of directors may designate and issue additional shares or

series of preferred stock that would rank senior to the shares of common stock as to dividend rights or rights upon our liquidation, winding-up, or dissolution

Nevada law and our charter documents could make it more difficult for a third party to acquire us and discourage a takeover, which could depress the trading price of our

common stock.

Nevada corporate law and our articles of incorporation and bylaws contain provisions that could discourage, delay, or prevent a change in control of our Company or changes in our management that our stockholders

may deem advantageous.

For example, holders of our common stock do not have cumulative voting rights in the election of directors, meaning that stockholders owning a majority of our outstanding shares of common stock will be able to elect all

of our directors.

In addition, because if and when we have 200 or more stockholders of record, we are subject to the “business combinations” provisions of the Nevada Revised Statutes, or NRS.

These provisions could prohibit or delay a merger or

other takeover or change in control attempt and, accordingly, may discourage attempts to acquire our Company even though such a transaction may be in our stockholders’ best interest and offer our stockholders the opportunity to sell their stock

at a price above the prevailing market price.

We may issue additional common stock, which might dilute the net tangible book value per share of our common stock.

Our board of directors has the authority, without action or vote of our stockholders, to issue all or a part of our authorized but unissued shares.

Such stock issuances could be made at a price that reflects a discount to, or a premium from,

the then-current market price of our common stock.

In addition, in order to raise capital, we may need to issue securities that are convertible into or exchangeable for a significant amount of our common stock.

We may engage in additional

capital raising transactions within the next twelve months, which would likely result in issuances of additional shares which would be dilutive to current shareholders.

These issuances would dilute the percentage ownership interest, which would

have the effect of reducing your influence on matters on which our stockholders vote, and might dilute the net tangible book value per share of our common stock.

You may incur additional dilution if holders of stock options, whether currently

outstanding or subsequently granted, exercise their options, or if the holders of warrants, whether currently outstanding or subsequently granted, exercise their warrants to purchase shares of our common stock.

A sale of a substantial number of shares of the common stock may cause the price of our common stock to decline.

Finance transactions resulting in a large amount of newly issued shares that become readily tradable, or other events that cause current stockholders to sell shares, could place downward pressure on the trading

price of our stock.

Some of our shareholders have registration rights to facilitate sales of large blocks of our common stock.

We have filed a shelf registration statement to allow registered sales by us of up to $100 million, which includes

the offer and sell shares of our common stock having an aggregate offering price of up to $40,000,000 from time to time pursuant to our At The Market Issuance Sales Agreement with H.C.

Wainwright & Co., LLC.

We may consider additional or

other capital raising transactions within the next twelve months, which would likely result in issuances of additional shares that would be dilutive to current shareholders.

In addition, the lack of a robust resale market may require a

stockholder who desires to sell a large number of shares of common stock to sell the shares in increments over time to mitigate any adverse impact of the sales on the market price of our stock.

If our stockholders sell, or the market perceives that our stockholders intend to sell for various reasons substantial amounts of our common stock in the public market, including shares issued

upon the exercise of outstanding options or warrants, the market price of our common stock could fall.

Sales of a substantial number of shares of our common stock may make it more difficult for us to sell equity or equity-related securities in

the future at a time and price that we deem reasonable or appropriate.

We may become involved in securities class action litigation that could divert management’s attention and harm our business.

We have not paid cash dividends on our common stock in the past and do not expect to pay cash dividends in the foreseeable future.

We have never paid cash dividends on our common stock and do not anticipate paying cash dividends on our common stock in the foreseeable future.

The payment of dividends on our common stock will depend on our

earnings, financial condition and other business and economic factors affecting us at such time as the board of directors may consider relevant.

If we do not pay dividends, our common stock may be less valuable because a return on your

investment will only occur if the market price of our common stock price appreciates.

Our shares of common stock have been thinly traded, so you may be unable to sell at or near ask prices or even at all if you need to sell your shares to raise money or

otherwise desire to liquidate your shares.

We cannot predict the extent to which an active public market for our common stock will develop or be sustained.

Our common stock is currently traded on The NASDAQ Capital Market and experiences periods when it is considered “thinly-traded.”

This situation may be attributable to several factors, including the fact that we are a small company that is relatively unknown to stock analysts, stockbrokers, institutional investors and others in the investment community that generate or

influence sales volume.

Furthermore, even if our stock came to the attention of such persons, they may be reluctant to follow us or purchase or recommend the purchase of our shares.

Therefore, there may be periods of several days, weeks or

months when trading activity in our shares is minimal, as compared to a seasoned issuer that has a large and steady volume of trading activity that will generally support continuous sales without an adverse effect on share price.

We cannot give

you any assurance that a broader or more active public trading market for our common stock will be sustained, or that current trading levels will be sustained or not diminish.

Concentration of ownership by our principal stockholders may limit your ability to influence the outcome of director elections and other transactions requiring stockholder

A significant percentage of our outstanding stock is held by a limited number of investors, including Richard E.

Uihlein, the chairman of our board of directors, who beneficially owns approximately

13.5% of our outstanding common stock as of February 28, 2023 (which does not include any shares issuable upon exercise of options and warrants) and the 10X Fund, LP , which now owns 10.4% of the issued and outstanding shares of common stock of

the Company as of February 28, 2023 (which does not include any shares issuable upon exercise of options and warrants).

Uihlein is also an investor in the 10X Fund as a limited partner but is not deemed to be a beneficial owner of, or have

a reportable interest in, any shares owned by 10X Fund.

As a result of their ownership of shares of common stock, Mr.

Uihlein and 10X Fund have and will have significant influence over corporate actions requiring stockholder approval, including

the following actions:

to elect or defeat the election of our directors;

to amend or prevent amendment of our certificate of incorporation or bylaws;

to effect or prevent a merger, sale of assets or other corporate transaction;

to control the outcome of any other matter submitted to our stockholders for vote.

Such persons’ stock ownership may discourage a potential acquirer from making a tender offer or otherwise attempting to obtain control of our company, which in turn could reduce our stock price or prevent our

stockholders from realizing a premium over our stock price.

Uihlein’s and 10X Fund’s significant ownership positions may deter or prevent efforts by other companies to acquire us, which could prevent our stockholders from

realizing a control premium.

As a result of Mr.

Uihlein’s and 10X Fund’s significant ownership and Mr.

Uihlein’s position as chairman of the board of directors, other companies may be less inclined to pursue an acquisition

of us or we may not have the opportunity to be acquired in a transaction that stockholders might otherwise deem favorable, including transactions in which our stockholders might realize a substantial premium for their shares.

Uilhlein and/or 10X Fund could sell or transfer a substantial number of shares of our common stock, which could depress the price of our securities or result in a

change in control of our company.

Uihlein has held common stock of the Company since 2012 and has not sold any of the shares of common stock that he has acquired during this time period, and although 10X Fund has been a long-time investor in the Company, neither

Uihlein nor 10X Fund are subject to any contractual restrictions with us on their ability to sell or transfer our common stock on the open market, in privately negotiated transactions or otherwise, and these sales or transfers could create

substantial declines in the price of our securities or, if these sales or transfers were made to a single buyer or group of buyers, could contribute to a transfer of control of our company to a third party.

Uihlein or 10X Fund of a

substantial number of shares, or the expectation of such sales, could cause a significant reduction in the market price of our common stock.

The outbreak of the novel strain of coronavirus, SARS-CoV-2, which causes COVID-19, could adversely impact our business, including our preclinical studies and clinical trials.

As a result of the COVID-19 outbreak, or similar future pandemics, we have and may in the future experience disruptions that could severely impact our business and our anticipated rollout and/or continuation of

our NAVIGATE trial, including:

delays or difficulties in enrolling patients in our clinical trials;

delays or disruptions in non-clinical experiments due to unforeseen circumstances at contract research organizations and vendors along their supply chain;

increased rates of patients withdrawing from our clinical trials following enrollment as a result of contracting COVID-19, being forced to quarantine, or not accepting in office or home health visits;

diversion of healthcare resources away from the conduct of clinical trials, including the diversion of hospitals serving as sites for our NAVIGATE trial and hospital staff supporting the conduct of such trials;

interruption of key clinical trial activities, such as clinical trial site data monitoring, due to limitations on travel imposed or recommended by federal or state governments, employers and others or interruption of clinical trial

subject visits and study procedures (particularly any procedures that may be deemed non-essential), which may impact the integrity of subject data and clinical study endpoints;

interruption or delays in the operations of the FDA and comparable foreign regulatory agencies, which may impact review and approval timelines;

interruption of, or delays in receiving, supplies of our product candidates from our contract manufacturing organizations due to staffing shortages, production slowdowns or stoppages and disruptions in delivery systems;

limitations on employee resources that would otherwise be focused on the conduct of our preclinical studies and clinical trials, including because of sickness of employees or their families, the desire of employees to avoid contact

with large groups of people, an increased reliance on working from home or mass transit disruptions.

These and other factors arising from the COVID-19 pandemic could worsen in countries that are already afflicted with COVID-19, could continue to spread to additional countries, or could return to countries where

the pandemic has been partially contained, each of which could further adversely impact our ability to conduct clinical trials and our business generally, and could have a material adverse impact on our operations and financial condition and

In addition, the trading prices for our common stock and other biopharmaceutical companies have been highly volatile as a result of the COVID-19 epidemic.

As a result, we may face difficulties raising capital through sales of our common

stock or such sales may be on unfavorable terms.

The COVID-19 outbreak continues to rapidly evolve.

The extent to which the outbreak may impact our business, preclinical studies and clinical trials will depend on future developments, which are

highly uncertain and cannot be predicted with confidence, such as the ultimate geographic spread of the disease, the duration of the outbreak, travel restrictions and actions to contain the outbreak or treat its impact, such as social

distancing and quarantines or lock-downs in the United States and other countries, business closures or business disruptions and the effectiveness of actions taken in the United States and other countries to contain and treat the disease.

Unresolved Staff Comments

Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.

What changed 10-K

Item 1. Business